The Rational Clinical Examination
David L. Simel, Drummond Rennie
Falls, Older Adults
David A. Ganz, Yeran Bao, Paul G. Shekelle, Laurence Z. Rubenstein
Sections:
Patient Scenario, Methods, Results, Scenario Resolution, The Bottom Line, References
Topics Discussed:
aging, elderly fall, fall
Excerpt:
"A 76-year-old woman walks into your office unaided, without any
noticeable gait abnormality, but reports that she has balance problems.
Her daughter fills out an intake questionnaire at her mother's
new-patient evaluation; the patient's medication list includes
hydrochlorothiazide, glyburide, aspirin, and temazepam as needed
for sleep. The daughter hands you a bone densitometry report indicating
that the patient has osteoporosis of the femoral neck. Since most
osteoporotic hip fractures occur after a fall, you would like to
calculate your patient's risk of falling to decide whether
she needs specific interventions to prevent falls.One third of community-dwelling individuals older than 65 years
fall every year.1,2 Falls were the most common
mechanism of injury (62%) among an estimated 2.7 million
nonfatal injuries among those 65 years and older treated in United
States emergency departments in 2001,3 indicating
that falls are a serious medical and public health problem. Five
percent to 10% of falls cause serious injuries such as
major head trauma, major lacerations, or fracture.2 Falls,
and especially injurious falls, predict placement in a skilled nursing
facility.4..."
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